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A Letter of Support For You and ThoughtsAbout COVID19
Co-published March 13th onGeriPal andPallimedDear Hospice and Palliative Care community,We are sad we cannot be together this year at the Annual Assembly and deeply concerned about the growing risk of the novel coronavirus. We want to send you a bit of encouragement, and some thoughts on how we can take care of ourselves, our teams, and our community in the setting of this new pandemic.We have always “punched above our weight” as a field, and the secret to that has been hard work, community, and being smart.We don ’t have to tell you to work hard. You and your teams know how to do this.1) Start social distancing from...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 13, 2020 Category: Palliative Care Tags: covid emergency preparedness pandemic rosielle sinclair smith tatum Widera yang Source Type: blogs

Mandated Queries of the Florida Prescription Drug Monitoring Program: A Three-Month Experience from a Cancer Center-Based Outpatient Palliative Medicine Clinic
This article represents the findings from the queries over the first three months ’ queries and brings further clarity to our initial findings.Methods This quality improvement (QI) project was reviewed and approved by the Orlando Health/UFHealth Cancer Center Joint Oncology Committee for 2018-19. We began recording results of all E-FORSCE queries occurring after the law ’s implementation of July 1, 2018 through September 30, 2018. We informed each patient that the PDMP query had become mandatory in Florida, and we discussed the results of each query with each patient. Each query examined the last 12 months of the patie...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 18, 2019 Category: Palliative Care Tags: kollas opioid pain quality improvement statte Source Type: blogs

Community Living for Hospice Patients: Don't " Put " People in Nursing Homes
by Lizzy Miles (@LizzyMiles_MSW)No one should ever be “put” in a nursing home. You might agree with this statement because you don’t like nursing homes, but that is not what I’m saying. The word “put” is offensive when you are describing a person, unless you are talking about putting a 3 year old in the time out corner because he colored on the walls.I would like to make the argument that no adult wants to be ‘put’ anywhere. You put dishes away, you do not put people away. When we are facing a situation in which the care needs exceed the family member’s ability, there are times where the best option is fo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 1, 2019 Category: Palliative Care Tags: caregiver caregiving communication geriatrics miles nursing home reframing social work social worker Source Type: blogs

Part 6 - Why Is Cancer Pain So Special?
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Cr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 6, 2019 Category: Palliative Care Tags: cancer opioids pain rosielle The profession Source Type: blogs

Part 5 - Why Do We Lump the Non-Cancer Pain Syndromes Together?
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Cr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 6, 2019 Category: Palliative Care Tags: opioid pain rosielle The profession Source Type: blogs

Part 4 - Everything We Were Taught About High Doses Was Wrong, and the Same Hand-Crafted Graph
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 4th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Cr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 5, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

Part 3 - Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Crafted Graph
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 3rd post in a series about opioid, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesThis is Part 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 4, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

Part 2 - We Were Wrong 20 Years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid Doses
by Drew Rosielle (@drosielle)This is the second in a series of several posts about many aspects of my current thinking about opioids.The first post is here:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Over-prescribing fueled the current drug overdose epidemic, and many of us who thought we were stamping out needless suffering contributed to the epidemic.A lot of what I read and believed about opioids early on in my career was wrong.I ’m old enough to remember those heady days in which there was a pretty large and ‘successful’ movement in American medicine to greatly liberalize...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.
by Drew Rosielle (@drosielle)Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.This is the first in a series of several posts about many aspects of my current thinking about opioids, with a focus on how my thinking about opioids has changed over the years.Opioids, opioids, opioids. The working title of these series of posts was in fact “Goddamned Opioids and the Goddamned Opioid Crisis’ because it’s a confusing time out there. A lot of us in palliative care have watched the unfolding, devastating, opioid overdose crisis in the US with dread and horror, as well as the multitude of r...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2019 Category: Palliative Care Tags: opioids rosielle The profession Source Type: blogs

Remembering Kathy Brandt: Hospice and Palliative Care Advocate
by Christian Sinclair (@ctsinclair)As some of you may already now, we lost a great voice and energy in our field of palliative care and hospice yesterday, August 4th, when Kathy Brandt died at home with her wife,Kimberly Acquaviva and son, Greyson. Kathy was diagnosed with ovarian cancer in January of 2019. Kathy most recently worked on the National Consensus Project Guidelines, 4th edition, as the writer and editor, which was released in 2018. She had over 30 years experience in the aging and end-of-life issues and was helpful to many organizations as theprincipal and founder of the kb group.In addition to all that work o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 5, 2019 Category: Palliative Care Tags: sinclair Source Type: blogs

March Madness, Palliative Care Style
by Sarah Rossmassler (@srossmassler)and Diane Dietzen (@ddietzen)As a part of our palliative care team ’s educational efforts for the medical residents at Baystate Medical Center, a 712-bed tertiary care academic medical center in Springfield, MA, we prepare and present an academic half-day about twice a year. This year, since our turn came in March, we organized the teaching around a March Madness theme. We had a ton of fun preparing it and felt it was an engaging format for both the palliative care faculty and the residents. In the spirit of Christian Sinclair’s call to use the format in palliative care (as NephMadne...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2019 Category: Palliative Care Tags: dietzen education interprofessional march madness rossmassler sports The profession Source Type: blogs

Living an Intentional Life: This is Water
by Bob Arnold (@rabob)I am not sure what led me to go from thinking about data and evidence in the literature to waxing philosophical recently. It may be that I saw Rufus Wainwright in concert and heard him sing “Hallelujah” with his sister, Lucy Roache Wainwright (Google it). It may be that one of our cardiology fellows died suddenly of unknown reasons and everyone at my hospital is a little fragile. Or that I was just on service and trying to balance the existential realities of sadness and dying with teaching learners and dealing with institutional budget cuts. But when I sat down today and tried to think of what ar...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 22, 2019 Category: Palliative Care Tags: arnold david foster wallace The profession Source Type: blogs

Celebrating 14 Years of Creating Content and Finding Emerging Creative Clinicians
by Christian Sinclair (@ctsinclair)Another year has passed and we arecelebrating the 14th Anniversary of Pallimed. Digitally speaking, 2005 is a pretty long time ago, before Twitter started and when YouTube was only 4 months old. I want to emphasize that what Drew Rosielle startedwith a single blog post as a 3rd year resident is something all of us are capable of doing. You have knowledge to share with a wider audience. At the time Drew was not an expert in hospice and palliative medicine, but he had passion, and he put his work where people could find it. The goal was not to build a brand or build followers, but to share ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2019 Category: Palliative Care Tags: meta sinclair Source Type: blogs

In Hospice, Time is an Illusion
by Lizzy Miles (@LizzyMiles_MSW)Lately I ’ve been thinking a lot about the perception of time and how it affects our patients. Because their time is limited, their perception of time and its value can often be magnified. This is our job, but this is the patient’s LIFE. We have to remember that for our patients, they may be hyper-focuse d on time. How do we help them feel good about timing and the time we spend with them? We can do this by being mindful of how we use our time with them and also how we show respect for their time.Set expectationsThere is research in the ambulatory care arena that says that patient satisf...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 22, 2019 Category: Palliative Care Tags: hospice perception social worker time Source Type: blogs

Comfort Care, Whatever Does That Mean?
by Michael Pottash (@mpottash)Comfort Care, whatever does that mean? This is the important question asked by my colleagues Anne Kelemen and Hunter Groninger in the September 2018 issue of JAMA Internal Medicine. The term is ubiquitous and its interpretation influences how patients with end stage illness are cared for at the end of their lives. In their article they argue that the language of Comfort Care is confusing and easily misunderstood. They suggest improving the understanding around end of life care and moving to a less ambiguous term for care of the dying. I worry that any term to describe dying care will always be...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 4, 2019 Category: Palliative Care Tags: comfort hospice hospital icu JAMA Internal Medicine palliative care pottash The profession Source Type: blogs